Is an aneurysm common for people with a bicuspid valve?

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I have had an aneurysm since diagnosis and I have been taking increased dose of metoprolol and started Losartan, an arb agent which has been shown to be effective in keeping the aneurysm from growing. Has a proposed effect of keeping the connective tissue from rupturing by inhibiting an enzyme. Size of mine still remains at 4.3 cm.
 
I have had an aneurysm since diagnosis and I have been taking increased dose of metoprolol and started Losartan, an arb agent which has been shown to be effective in keeping the aneurysm from growing. Has a proposed effect of keeping the connective tissue from rupturing by inhibiting an enzyme. Size of mine still remains at 4.3 cm.
My aortic root aneurysm was 4.1 cm during aortic valve replacement surgery. The surgeon did not intervene in the aneurysm, I console myself that cardiovascular surgeons know better.
 
Surgeon told me and I have read that 4.5 is where you get it done. Judgement call at time of repair. I have a ct aortic angiogram every couple of years. Echo’s are inconsistent even in the hands of experienced sonographers. The angio looks at the interior dimension of the wall of your aortic arch. Important to visualize the intima of the vessel. Take losartan and up your beta blocker to as much as I can tolerate. Seems to be working running 3 miles several times a week. Here is a study that points to folks who have Marfan’s syndrome https://pubmed.ncbi.nlm.nih.gov/16601194/. These people have high incidence of aortic rupture and that is why I thought about talking to my cardiotron about it and he brought the same study up and we started me on 25mg. Few months ago I upped it to 50mg. I do not have history of hypertension, btw. This is for prevention of having my chest cracked open again.
Tony
 
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I had BAV, first replacement 2001. Feb 2022 had ascending aortic aneurysm replaced and had my homograft valve replaced at the same time even though it wouldn't have needed replacement but for the aneurysm, which was at 5.1 I believe. My surgeon monitored me over 3 plus years until the aneurysm grew to 5.1. It is a big surgery, but at the right facility, they know how to fix this. Doing well now 2.5 years later. All the best to you!
 
Jeff, maybe the difference lies if you already have the hood open on car do you fix both? If someone is found at 4.5cm as outpatient then waiting to 5 is warranted. YMMV
 
Found indications for repair in UpToDate

condition Aneurysm diameter*
Sporadic (not associated with disease below)
Ascending ≥5.5 cm
>5.0 cm (ACOE and low operative risk)
Isolated arch aneurysm ≥5.5 cm
Marfan syndrome (MFS), familial thoracic aortic aneurysm/dissection (FTAAD), others¶
Without risk factorsΔ◊ ≥5.0 cm
With risk factorsΔ◊ ≥4.5 cm
Loeys-Dietz syndrome (LDS)
Without risk factorsΔ◊ ≥4.5 cm
With risk factorsΔ◊ ≥4.0 cm
Bicuspid aortic valve (BAV)
Without risk factorsΔ◊ ≥5.5 cm
>5.0 cm (ACOE and low operative risk)
With risk factorsΔ◊ ≥5.0 cm
Concomitant aortic valve surgery ≥4.5 cm
 
Jeff, maybe the difference lies if you already have the hood open on car do you fix both? If someone is found at 4.5cm as outpatient then waiting to 5 is warranted. YMMV
You are right at this point, but do not forget that there is also the possibility that your existing aortic aneurysm may not progress after mechanical aortic valve replacement surgery. No one can predict that. As in my case, my aneurysm was 4.1 cm when my valve was replaced. I thought like you and asked my surgeon why you did not intervene in my aneurysm during the same operation.
His answer to me was as follows: "During the operation, I saw that your aorta was a little thin and I decided to leave it as it is"
To be honest, I could not say anything against this explanation, after all, this is his speciality.
However, I think we should also take into account that every intervention in your body can bring different risks. For example, in abdominal aortic aneurysms, sometimes the grafts can slip from where they are located.
 
Absolutely, less is better if you can do it. I am glad I have my native vessel and how it will respond to normal physiologic stresses. Replace that segment and you lose some neurological connections that can affect your ability to respond in heart rate, vaso constriction/dilation, etc..
 
It's very common. Jet of blood hitting same spot on aorta causes it to weaken and an aneurysm to form. Once the valve is replaced, the jet goes away, but the damage to the aorta doesn't so it will continue to weaken over time. They should have done a root repair at the time of surgery so hopefully you're seeing a different surgeon now.
 
@Jeff Lebowski Like you I had an aneurysm was 4.1 cm and I asked the surgeon to fix it during my BAV surgery (Dec. 2020) with On-X. He said he would decide during surgery. He did not make the repair, I was so sad when I was told it wasn't fixed. He said it was very "healthy" looking and didn't want to touch it. I have asked 2 other cardiologists about it and they both said, if it's healthy looking at 4.1 it's best not to do anything. Most times with the aorta valve fixed, the aneurysm doesn't grow but, it can.... I just had my annual echo and it's still 4.1. Yay! My 4 year surgery anniversary is coming up Dec. 3rd and still no change! At 68, I'm feeling and doing amazing! But truthfully, I do get a little anxious during my yearly exam's and still wish it was fixed.
 
I remember Ross, nice bloke. He'd left "here" by that time and I met him "over there". IIRC he survived that event and it was a GI bleed that got him in the end.
His dissection was in 1994 so long before he was here. He had the Bentall procedure then. His valve was damaged, so he had a valve repair. It was replaced in 2001, which is what brought him here.

The end of his life started with a GI bleed and ended with total organ failure.

I don't know his story by memory, but know where to find the details. I just remembered that his root dissected long before 5.5 cm so went to look for the number.
 
I had BAV, first replacement 2001. Feb 2022 had ascending aortic aneurysm replaced and had my homograft valve replaced at the same time even though it wouldn't have needed replacement but for the aneurysm, which was at 5.1 I believe. My surgeon monitored me over 3 plus years until the aneurysm grew to 5.1. It is a big surgery, but at the right facility, they know how to fix this. Doing well now 2.5 years later. All the best to you!
So this is fixable at the right centre with the right surgeon? I don't know risk it carries for someone who already had an OHS but I'm hoping it doesn't reach the point where it is required since my first time recovery was almost 6 months for me given I had a very delayed surgery. Don't wanna go through the entire ordeal once again. Hoping the Metoprolol and losartain does it's jobs and keeps it from growing anymore.
 
thanks for that history ... I hope his family have adjusted to the loss.

--,-'<@
They haven't checked in since shortly after the funeral. Hard to believe it's been almost 11 years. I noticed that he still has the most posts on this site by far. If memory serves me right, it's been about 15 years since he left.
 
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I wonder the same thing!
I've once seen an article in a newspaper quoting a researcher in a Queensland (Brisbane) hospital express the opinion that replacing the aorta with a tube conferred two negatives:
  1. an increase in the velocity of the pulse up into the remaining artery and into the brain
  2. a conjecture that this caused some potential harm to the brain
of course it being a news paper (not a journal) no rigor was associated with that "opinion" and despite having searched for it (it was about 2014) I've not seen anything else to explore that avenue.

I do know that the artery wall is not just a tube and contributes to blood flow (even if its 'injured' by the connective tissue disorder conferred on upon us who have BAV); so it may just be that the artery section replaced provides some benefit in its "impaired" state .

https://www.sciencedirect.com/science/article/abs/pii/S002228280900426X

In the steady state, the cyclic stretching of artery walls sustains a quiescent, contractile VSMC phenotype and slow turnover of extracellular matrix (ECM) proteins.


So basically I'm not sure, and I'm suspicious that they also aren't sure based on the same things

¯\_(ツ)_/¯
 
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